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Biomedical subjects

J F Lucey

Publications and source records attributed to J F Lucey.

At least 37 records · Page 2Linked to original sources
PubMed1988

Perinatal intracranial hemorrhage and retinopathy of prematurity: currently nonpreventable complications of premature birth?

There is now considerable evidence that the control of cerebral circulation in sick small infants is sometimes seriously deranged and subject to wide fluctuations during neonatal care. Our current preoccupation with looking at oxygen administration and peripheral arterial oxygen tensions as the only cause of ROP is not likely to be productive. Until we know more about the causes of cerebral blood flow fluctuation, IVH, asphyxia, and their effects on the retinal circulation, we are not apt to make much progress. There is a strong association between retinopathy and IVH in premature infants. With our current knowledge, we are unable to prevent or to treat either IVH or ROP. The public should be better informed that both of these conditions are usually unavoidable complications of premature birth.

Asphyxia Neonatorum↗
PubMed1987

Growth and development of transcutaneous monitoring in the U.S.A.--1978-1986.

Surface blood gas monitoring is an invaluable clinical technique. It is, unfortunately, subject to many errors unless carefully carried out. This can be done by clinicians. Clinicians, however, cannot be responsible for the cumulative effects of changes in the electrodes made by manufacturers. Before a modified electrode is approved for use its accuracy under clinical conditions and at high arterial PO2 tensions has to be established. In America this has not and is not being done. The F.D.A. met in December, 1986, to consider this problem. Recommendations are expected to be published in 1987. In any new regulations similar but not identical requirements for accuracy should be demanded from pulse oximeters, as these devices have their own unique limitations under hyperoxic and hypoxic conditions.

Electrodes↗
PubMed1987

Episodic abnormalities in transcutaneous oxygen (TcPO2) recorded during neonatal intensive care.

An automated TcPO2 data system was tested and used to: 1) quantitate the frequency and duration of hypoxemic and hyperoxemic events experienced during the first three days after birth by 25 very low birth weight infants, and 2) determine whether hypoxemic events were associated with the occurrence of periventricular-intraventricular hemorrhage. During the first three days after birth, infants experienced a median of 41 episodes with a TcPO2 less than 40 torr having a cumulative duration of 37 minutes, and a median of 28 episodes with a TcPO2 greater than 100 torr having a cumulative duration of 14 minutes. Most episodes were less than 30 seconds in duration, but in some infants the duration was longer. There was no association between the occurrence of periventricular-intraventricular hemorrhage and either the frequency or cumulative duration of episodes with a TcPO2 less than 40 torr. A major problem with automated TcPO2 data systems is the inability of currently available systems to recognize inaccurate TcPO2 data. Twenty-four per cent of the summary TcPO2 monitoring data collected in this study was contaminated with unreliable TcPO2 values. Before automated TcPO2 data systems can be recommended for widespread research use or for medicolegal documentation, the problem of data contamination must be resolved.

Blood Gas Monitoring, Transcutaneous↗
PubMed1987

Randomized controlled trial of exogenous surfactant for the treatment of hyaline membrane disease.

We conducted a prospective, randomized, unblinded, controlled trial of exogenous bovine surfactant (surfactant TA) in premature infants requiring ventilator support for the treatment of severe hyaline membrane disease. Forty-one low birth weight infants with severe hyaline membrane disease were randomly assigned to saline or surfactant therapy and treated within eight hours of birth. Significant improvements in oxygenation (increased arterial/alveolar PO2) and respiratory support (decreased mean airway pressure) were seen in the group receiving surfactant within four hours after treatment. These improvements were maintained in the surfactant-treated infants, who also had fewer pneumothoraces and fewer number of days in environments of fractional inspiratory oxygen greater than 0.4 mm Hg. No problems were associated with administration of surfactant, and no acute side effects were detected. We conclude that exogenous surfactant, administered early in the course of severe hyaline membrane disease, is an effective therapy that can diminish the amount of respiratory support required during the first 48 hours of life.

Animals↗
PubMed1985

Use of an iridium-oxide transcutaneous carbon dioxide electrode on adult surgical patients.

A new iridium/iridium-oxide electrode heated to 42 degrees C was used to monitor transcutaneous carbon dioxide levels during surgery in 27 adult patients. The purpose of this study was to compare arterial and transcutaneous CO2 values. This metal electrode performed similarly to glass CO2 electrodes. In addition, its lower operating temperature may reduce the risk of skin injury and more quickly reflect changes in local tissue perfusion.

Adolescent↗
PubMed1984

A reexamination of the role of oxygen in retrolental fibroplasia.

A critical review of the literature of retrolental fibroplasia indicates that the cause of this disease is not yet known. Oxygen is certainly a critical factor but it is still not possible to make precise recommendations as to the amount or the duration of therapy that is safe. We have overemphasized the role of oxygen in the past, and as a result of this the false impression has been created that RLF is a disease that can be prevented. This gross oversimplification of a complex disease with multiple causes has resulted in many unjustified malpractice claims. A study of the present epidemic indicates that excessive oxygen administration probably plays a minor role, in contrast to the first epidemic in which prolonged oxygen administration was clearly a major factor. A reasonable working hypothesis is that the developing retina is highly sensitive to any disturbance in its oxygen supply, either hyperoxemic or hypoxemic. The retinal circulation is subject to the same wide fluctuations as the cerebral circulation in newborn infants. The very low-birth-weight, sick premature infant suffers from a number of conditions, many of which can seriously disturb the retinal circulation, resulting in hypoperfusion and ischemia. These factors (immaturity, hyperoxia, hypoxia, blood transfusions, intraventricular hemorrhage, apnea, infection, hypercarbia, hypocarbia, patent ductus arteriosus, prostaglandin synthetase inhibitors, vitamin E deficiency, lactic acidosis, prenatal complications, genetic factors) may all be present in an infant. They may interact to produce various degrees of retinal damage. Nearly all of these factors cannot be prevented or controlled by our present methods of care. Unfortunately, this means that RLF is an extremely difficult disease to prevent, treat, or investigate. A disease of this complexity with multiple causes will require very large numbers of infants in any controlled study of a therapy. Retrolental fibroplasia should not be considered an avoidable iatrogenic disease in very low-birth-weight infants. Its cause in these infants is not known.

Anencephaly↗
PubMed1983

Obstetric events and risk of periventricular hemorrhage in premature infants.

The relationships between selected obstetric factors and the occurrence of periventricular-intraventricular hemorrhage (PIH) was studied in a group of 77 infants weighing 1,200 g or less at birth. The diagnosis of PIH was made using ultrasonography or at autopsy in 42 (55%) of these infants. Univariate associations between PIH and gestational age (less than 30 weeks), duration of labor (greater than or equal to six hours), and vaginal delivery were found. Multivariate analysis, however, did not substantiate an association between PIH and any single obstetric factor. Log-linear analysis of multiway frequency tables showed significant second-order associations of PIH with gestational age and presentation during delivery and with duration of labor and presentation. A model for the risk of PIH based on gestational age, presentation, and duration of labor was derived using stepwise logistic regression. This model correctly predicted PIH in 70% (55) of the infants. Although obstetric factors may have a role in the pathogenesis of PIH, the interactions among factors, rather than single factors alone, are important.

Cerebral Hemorrhage↗
PubMed1982

Real-time ultrasonography: its use in diagnosis and management of neonatal hydrocephalus.

Real-time ultrasonography of the brain is useful in the examination of neonates with suspected hydrocephalus. Abnormalities of the cerebral ventricles can be identified and changes in ventricular size determined with repeated studies performed at the bedside. The response of hydrocephalus to medical and surgical intervention can be monitored. We studied cases of hydrocephalic infants with myelomeningocele, posterior fossa cyst, posthemorrhagic hydrocephalus, meningitis, and congenital intracranial teratoma. We also studied the role of ultrasonography in the diagnosis and follow-up of these cases.

Brain Neoplasms↗
PubMed1981

Transcutaneous diagnosis in the high-risk neonate.

In the newborn nursery, transcutaneous measurement of oxygen tension has already shown its value for continuous monitoring of the status of tissue oxygenation and thus for assessing the deleterious effects on the neonate of various routine medical and nursing procedures. The technique-which is noninvasive-holds promise of a number of significant applications in adult medical care.

Blood Gas Analysis↗
PubMed1981

Neonatal mortality risk for the eighties: the importance of birth weight/gestational age groups.

Since 1976 a computerized data base has been used to store information on babies admitted to two intensive care nurseries serving the Vermont/New Hampshire region. The data base now allows reporting "neonatal" mortality by birth weight/gestational age (BW/GA) groupings for 1976--1979. For all BW/GA groups, except the most immature infants, there has been marked improvement compared to data gathered in the sixties (ie, mortality has decreased). These data are probably applicable to most other centers providing neonatal intensive care. The use of BW/GA categories provides the most reliable way of objectively comparing statistics from one center to another. Differences between two centers were observed when birth weight specific rates were used, but were largely abolished by using BW/GA groups. Data gathered in this way will be increasingly important for comparisons between centers and across years and when evaluating the effectiveness of new therapeutic interventions.

Birth Weight↗